Monthly Scientific Update – June 2022 (Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs. Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma)

The role of locoregional therapy in treating intrahepatic cholangiocarcinoma (iCCA) patients is still limited. Therefore, a group of researchers assessed if using a hepatic arterial infusion pump (HAIP) to deliver high-dose chemotherapy directly into the liver is similar to surgical resection.

The researchers enrolled 319 patients with multifocal iCCA, including

1. 141 patients in the HAIP group who had an unresectable multifocal iCCA between January 1st, 2001, to December 31st, 2018, from the same cancer center
2. 178 patients in the surgical resection group who underwent a curative-intent surgical resection between January 1st, 1990, and December 31st, 2017, from 12 participating institutions.

Although the HAIP treated group has statistically significant more disease aggressive parameters, including:

1. More patients have tumors involving more than one liver lobe
2. More patients have four or more liver lesions
3. Larger tumors size
4. More lymph node involvement.

There was no statistically significant difference in:

1. Median overall survival was 20.3 months in HAIP compared to 18.9 months in the surgical resection group.
2. 5-years overall survival rate in patients with 2-3 liver lesions treated with HAIP (23.7%) compared with surgically resected (25.7%)
3. 5-years overall survival rate in patients with 4 or more liver lesions treated with HAIP (5%) compared with surgically resected (6.8%)

There was a significant difference in the 30-day postoperative mortality rate in favor of the HAIP group: 0.8% in the HAIP compared to 6.2% in the surgical resection group.

After adjustment for specific tumor parameters that decrease patients' survival and treatment outcome, including the tumor size, the number of tumor lesions, and lymph node metastases, the HAIP showed a 25% reduction in the risk of mortality compared to surgical resection; although it was not statistically significant there was a trend toward the significance (P < 0.07)

In conclusion, patients with multifocal iCCA treated with either HAIP or surgical resection had similar overall survival (OS). However, future clinical trials are needed to better identify patients who could benefit from HAIP versus those who will benefit from surgical resection, carefully considering procedure side effects.

Read the full article, “Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs. Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma”, here.